Fuchs Heterochromic Iridocyclitis (Fuchs Heterochromic Uveitis) Medication

Updated: May 09, 2017
  • Author: Neerav Neel Lamba, MD, MBA; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

The inflammatory activity in the anterior chamber is generally mild and can fluctuate over time. With minimal inflammation in an asymptomatic patient, chronic use of topical steroids is not indicated. However, FHI can be associated with pain, floaters, increased anterior segment inflammation, and elevated intraocular pressures. These cases may warrant short-term treatment with a topical corticosteroid. [2]

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects; they modify the body's immune response to diverse stimuli.

Prednisolone acetate suspension 1% (Pred Forte)

Generic preparations may be significantly less potent because of markedly larger particle sizes, approximately 10 µm in diameter. The larger particles decrease the effective exposure of drug to ocular surfaces, reducing absorption and potency. Rebounds may occur when switching from proprietary to generic prednisolone acetate 1% suspension on a dose-for-dose basis.

Initial dosage is titrated according to the degree of inflammation, and the therapeutic goal is to reduce the inflammation to the level prior to the flare-up.

Drops should be spaced at least 5 min apart to avoid dilution effects. Gentle eyelid closure or punctal occlusion can significantly decrease upper airway irritation and systemic absorption. A second drop given immediately after the initial drop does not increase potency because the conjunctival cul-de-sac only holds about 10 microliters, and each drop contains 40 microliters.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic, anti-inflammatory, and antipyretic effects. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms also may exist, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Topical formulations provide reasonable anti-inflammatory therapeutic effect without the major adverse effects of steroids. Although very potent analgesics, NSAID drops are generally far less potent than steroids.

Diclofenac ophthalmic (Voltaren)

Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclooxygenase, which, in turn, decreases formation of prostaglandin precursors. May facilitate outflow of aqueous humor and decrease vascular permeability.

Ketorolac ophthalmic (Acular)

Inhibits prostaglandin synthesis by decreasing activity of the enzyme cyclooxygenase, resulting in decreased formation of prostaglandin precursors, which, in turn, results in reduced inflammation.

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